Effectiveness of Group Interventions for Trauma and Depression Among Immigrant and Refugee Children: A Meta-Analysis

Background and Purpose: Group work has been recognized as useful in working with adolescents and young adults. Immigrant and refugee children and adolescents are a population at risk for developing post-traumatic stress disorder, anxiety, and depression. The literature describes a range of group interventions designed to reduce psychopathology and improve well-being of displaced children. This study provides a meta-analysis of psychosocial group interventions for post-traumatic stress symptoms (PTSS) and depression among refugee and immigrant children and adolescents.

Methods: A systematic search following the Cochrane Handbook for Systematic Reviews of Interventions was conducted to identify group-based intervention studies with randomized and non-randomized controlled trials, and single group pretest posttest designs. The target population included immigrant and refugee children and adolescents under the age of 18 with PTSS and possible accompanying depression. The PICO (population, intervention, control, outcome) framework was applied to examine relevant characteristics of the studies. Each study was reviewed for risk of bias by two reviewers. Between-group effect sizes (ES) and pre-post ES were reconstructed for each trial. A meta-analysis was performed by pooling group ES on PTSS and depression across multiple studies using the random effects model.

Results: The search yielded 16 studies utilizing 6 interventions (CBT, EMDR, mindfulness-based intervention, art therapy, crisis management, and somatic based interventions) with 976 participants. Most studies lacked rigorous designs. Non RCT studies showed serious risk of bias in many domains. For studies with control groups, meta-analysis of between-group ES with random effect model yielded a significant small effect on PTSS (d = - .31, 95% CI [-.65, .03]) but the effect on depression was not meaningful. Within-group ES demonstrated medium effects on PTSS (d = -.66, 95% CI [-.86, -.46], p < .001) and on depression (d = -.51, 95% CI [-.79, -.23], p < .001), with substantial heterogeneity (I² = 65.11%, Q = 40.13, p < 0.001) and (I² = 77.01%, Q = 43.50, p < 0.001) respectively. Guided by literature, subgroup analyses were conducted based on immigration status, unaccompanied minors vs. children with their families, host countries, age, residence setting, and intervention characteristics for both outcomes. While there were no statistically significant differences on PTSS, ES for depression were statistically significant on residence setting and number of sessions. There were larger effects for depression with interventions delivered for children living in institutions (d = -.94, 95% CI [-.98, -.89]) and those delivered in more than ten sessions (d = -.65, 95% CI [-.79, -.51]). A major limitation of the studies was the lack of reporting on group treatment factors. Most studies provide inadequate information on group composition, process, and leadership. Also, few studies analyzed the interaction effects of compounding variables including age, pre-migration factors, and race/ethnicity.

Conclusions and Implications: There is good evidence for the benefit of group work for refugee and immigrant children. However, most studies showed serious risks of bias across many domains. Future group work studies should consider using more rigorous designs and including description and analyses of group factors.